Tamil Nadu Lockdown Diary: In Kandamangalam Block, health workers battling COVID-19 say keeping emotions in check while on duty is a daily struggle

Editor’s note: This  multimedia series documents  the mechanics of how 12 districts in Tamil Nadu worked during the COVID-19 lockdown; told through the stories of healthcare workers, sanitary workers, district officials, other essential workers, administrators, locals and patients. The series resulted from three weeks of travel through the state.​ 

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A sleepy middle-aged man walks out of his home to determine the source of noise, in an otherwise dead neighbourhood, as is the case with all COVID 19 containment zones. He acknowledges the familiar faces gathered just across the barricade erected around his compound. Leading the group is chief civil surgeon and block medical officer (BMO) Dr Aarthi R, who has worked in Kandamangalam Block for 22 years. This is her home ground. This is where she started as a medical officer and is now on top, as BMO. Alongside her, a team of health nurses and health supervisors, central among them 27-year-old Neela. This neighbourhood falls under the precint where Neela is a village health nurse. [caption id=“attachment_8476461” align=“alignnone” width=“825”]  The Kangamangalam Block team headed by Dr Aarthi R gets ready to enter the containment zone, which is just a few hundred meters away from the Siruvanthadu Primary Health Centre. Firstpost/Greeshma Kuthar[/caption] They are paying a visit to the most “dreaded man” in the neighbourhood, a COVID-19 positive patient who has just returned after 14 days in a facility. Mr X looks fine. He says he feels fine.To me, he looks healthy. And bored. His mother, who’d followed him out, says  the same. “I never had any symptoms, even when I tested positive,” Mr X tells us. He’s standing behind the barricades, more than 10 feet away. There are barricades aplenty. More so because this containment zone is just a few hundred meters away from the Siruvanthadu Primary Health Centre. Navigating the barricades is like playing an episode of Temple Run. We pass three before we reach Mr X’s lane. I’ve already slipped twice. There are two diagonally opposite leading up to his home. Two more either side of his home. A sticker on the door announcing Mr X’s condition. “Though we are taking all precautions required, all those who have tested positive in my block are asymptomatic, like Mr X here. Maybe the strain of the virus isn’t as virulent here, maybe our immunity is good,” explains Dr Aarthi as she checks on those on the same lane as Mr X. The precautions Dr Aarthi mentions is what has now turned into her team’s primary duty: to  monitor, track and follow up with every individual in the block who may exhibit severe acute respiratory infections (SARI) or influenza-like illness (ILI) Respiratory symptoms are central to both, as is the case for the new pandemic in town, COVID 19. Both are medical terms which have been put into wider popular use by the World Health Organisation (WHO), after they insisted on routine surveillance of hospitalised SARI and ILI cases in the aftermath of the 2009 H1N1 pandemic. A  study by the Centre for Disease Control and Prevention put the number of deaths worldwide, just during the first year of the virus, between 151,700 and 575,400. Since then, many countries across the world, including India, have attempted to monitor patterns of hospitalised SARI and ILI outpatients through their public healthcare systems. So, it helps Dr Aarthi’s team that surveillance mapping and techniques are already in place for keeping track of COVID-19 in Kandamangalam Block, which is home to 1,40,000. Kandamangalam Block has five Primary Health Centers at Puranasingupalayam, Kondur, Siruvanthadu, Rampakkam and Kandamangalam. These serve as the nodal points for all mapping operations. Additionally, there are 31 Health-Sub Centres (HSC). The population to be monitored has been split up among healthcare workers in these centres, who track them every day through phone calls and house visits where they note down those who are displaying symptoms or are developing symptoms. These visits mean direct exposure, say Neela and T Samaresan, 58, the block health inspector. One such visit sent the entire team into a frenzy, recollects Neela. April was when everybody was still trying to grasp how to track those with symptoms. And those who eventually end up testing positive. With many returning from outside the district, healthcare workers were plagued with queries. [caption id=“attachment_8476361” align=“alignnone” width=“825”]  Dr Aarthi’s team sets out for the inspection of homes in the containment zone. Firstpost/Greeshma Kuthar[/caption] In a similar fashion, Mr A approached Neela and Samaresan. After returning from Chennai, he submitted his test sample at Villupuram and went to his village. He had many questions for Neela the day she visited his area, all of which she had patiently answered. In a day, his test results reached Dr Aarthi. Mr A was positive. “Neela was scared,” says Dr Aarthi. “She spoke to him for a long time and though she was wearing a mask, he wasn’t. Samaresan also spent considerable time talking to Mr A. Basically, the entire team stood exposed.” The same day, Dr Aarthi directed her team to go back into the area and collect swabs of all those in contact with Mr A. “Everybody panicked. But this is our work. We did what had to be done,” explains Sankar M, 55, block health supervisor, who oversaw the swab collection. Dr Aarthi had to do something to put her team at ease. She decided to test Samerasan for the virus, as he was older and had spent the most amount of time with Mr A. He eventually tested negative. The fear subsided a little after this, explains Neela. Samerasan, who was slated to retire but extended his tenure by a year after the onset of the pandemic, has another take: “Since we started on 28 February many of us have not even taken a single Sunday off. No time for fear!” Neela says they are informed as soon as anyone shows a symptom of COVID-19. “In fact, people are so paranoid about tracking those with symptoms that we get a call the minute somebody as much as coughs on the street. But that doesn’t mean we instantly test that person. We monitor for a day or two, and proceed if symptoms persist,” she explains. But what about cases like Mr X and Mr A, both asymptomatic? The strategy is to closely monitor those living with the positive patients (referred to as primary contacts, in COVID-19 parlance) who might be more at risk. Those with comorbidities. Which means, those who suffer from a particular condition or conditions which might put them at a higher risk from COVID-19 exposure. Diabetes, hypertension, cardiovascular disease and lung disease are red flags. If a primary contact has one or more of the red flags, they are tested on high priority. The other high priority group for Dr Aarthi was all expecting mothers. In March, all five PHCs mapped those who were expecting or delivered post-February. Once this was done, the priority of the sector health nurses and community health nurses kept track of all those who are under antenatal and postnatal care. They are supplied with zinc and calcium supplements in regular intervals on the basis of a chart which has been drawn up. Daily reports are submitted to Dr Aarthi, who performs scans on expecting mothers across the five PHCs and surgeries when required. A total of 845 women are being monitored and of these, 145 have been tested for COVID-19 on a priority basis. Two tested positive and were asymptomatic, but Dr Aarthi didn’t want to take any chances. One of them, who is seven months pregnant, was transferred to an isolation ward at the district headquarters. The other delivered a baby at Villupuram Medical College this week. Both mother and baby are fine. What works for Kandamangalam Block, explain Poongodi and Sankar, the most senior healthcare workers of the team, is that Dr Aarthi is on top of every survey to be done, every day. [caption id=“attachment_8476311” align=“alignnone” width=“825”]  The team credits Dr Aarthi R (centre) as playing a crucial role in managing emotions and keeping their focus on the task at hand. Firstpost/Greeshma Kuthar[/caption] Her role of managing the team’s emotions is crucial in keeping us going, says Sankar. In fact, Sankar saw the worst of it. He was in charge of the first quarantine facility which housed those who returned from outside the district. They had been highly irritable and difficult to work with, as all of them wanted to be let off, since none of them were displaying symptoms. Some attempted escapes but were unsuccessful. For 14 days, Sankar and his team negotiated with them constantly, helping them see reason in their isolation. This, while also performing other duties, most important of which are the daily surveys and mapping.“When that batch left from the quarantine facility, they left with no complaints and an understanding of COVID-19. Communication is crucial,” says Sankar.